结直肠癌癌前病变或癌变行内镜黏膜下剥离术患者手术标本的临床病理学特征  

Clinical and pathological characteristics analysis of colorectal precancerous lesion and colorectal cancer patients undergoing endoscopic submucosal dissection for epithelial neoplasm

作　　者：秦云 商晓青[1] 卢晓红 刘洪波[1] 张立英 QIN Yun;SHANG Xiaoqing;LU Xiaohong;LIU Hongbo;ZHANG Liying(Department of Pathology,Beijing Daxing District People’s Hospital,Beijing 102600,China)

机构地区：[1]北京市大兴区人民医院病理科,北京102600

出　　处：《临床与病理杂志》2024年第9期1191-1196,共6页Journal of Clinical and Pathological Research

摘　　要：目的:内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)是治疗结直肠癌癌前病变或癌变的重要手术方法之一,本研究旨在分析2017年至2021年间相关患者的临床病理特征及随访情况。方法:收集患者的一般资料(年龄、性别、病变位置等)、术前活体组织检查(以下简称“活检”)标本/ESD手术标本的病理诊断结果(病变性质、病变大小、切缘情况等)、术后随访结果(病变复发、病变相关进展及死亡等)。结果:共收集134例患者的相关数据,年龄为(56.9±11.5)岁,其中40岁以上患者比例高达93.3%(125/134)。ESD标本中,17.9%(24/134)为Tis/SM1期结直肠腺癌,23.9%(32/134)为未伴癌浸润的高级别上皮内瘤变,58.2%(78/134)为低级别上皮内瘤变。128例术前活检病理报告可查询,术前肠镜活检与ESD手术标本的诊断符合率为60.9%(78/128),35.9%(46/128)病理升级,3.1%(4/128)病理降级。病变完整切除率为82.8%(111/134),其中病变范围较大、病变级别较高者不完整切除的概率较高。本研究有20例Tis期和4例SM1期结直肠腺癌病例,其中30.0%(6/20)的Tis期和50.0%(2/4)的SM1期结直肠腺癌不符合治愈性切除标准。105例患者可追踪术后身体情况,均未发生疾病相关进展及死亡情况;71例患者术后进行了肠镜复查,4例患者在3~24个月疾病复发,远期复查未出现复发情况。结论:ESD作为治疗结直肠癌及癌前病变的有效手术方式,具有较强的治愈性作用,但术前活检病理诊断可能会低估,需要结合内镜下形态综合判断以决定手术方式。Tis/SM1期结直肠腺癌非治愈性切除概率较高,需对此类患者采取相应措施并嘱定期返院行肠镜复查。此外,建议对40岁以上人群进行系统性风险评估,以扩大筛查获益人群。Objective:Endoscopic submucosal dissection(ESD)is an important surgical method for treating colorectal cancer precancerous lesions or early-stage cancer.This study aims to analyze the clinicopathological characteristics and follow-up outcomes of related patients from 2017 to 2021.Methods:Data were collected from patients’general information(age,gender,lesion location,etc.),preoperative biopsy specimens/pathological diagnoses of ESD surgical specimens(lesion nature,lesion size,margin status,etc.),and postoperative follow-up outcomes(lesion recurrence,disease progression,and death).Results:A total of 134 patients were included in the study,with an average age of(56.9±11.5)years.Among them,93.3%(125/134)were over 40 years old.In the ESD specimens,17.9%(24/134)were Tis/SM1 stage colorectal adenocarcinoma,23.9%(32/134)were highgrade intraepithelial neoplasia without cancer invasion,and 58.2%(78/134)were lowgrade intraepithelial neoplasia.Of the 128 preoperative biopsy pathology reports available for review,the diagnostic concordance rate between preoperative colonoscopy biopsy and ESD surgical specimens was 60.9%(78/128),with 35.9%(46/128)showing pathological upgrading,and 3.1%(4/128)showing pathological downgrading.The complete resection rate of lesions was 82.8%(111/134),with a higher probability of incomplete resection for larger and higher-grade lesions.This study included 20 cases of Tis-stage and 4 cases of SM1-stage colorectal adenocarcinoma.Among these,30.0%(6/20)of Tis-stage and 50.0%(2/4)of SM1-stage adenocarcinomas did not meet the criteria for curative resection.Postoperative follow-up data were available for 105 patients,and none had disease progression or death.71 patients underwent colonoscopy re-examination postoperatively,and 4 patients had disease recurrence within 3 to 24 months,with no recurrence observed on long-term follow-up.Conclusion:ESD is an effective surgical method for treating colorectal cancer and precancerous lesions,with strong curative effects.However,preoperative biopsy pathology

关 键 词：内镜黏膜下剥离术 结直肠癌 癌前病变 SM1期结直肠腺癌 临床表现 病理特征 治愈性切除 

分 类 号：R73[医药卫生—肿瘤]